Why marriage won’t cut your medical bills

Conventional wisdom says marriage is good for your health, but science isn’t so sure

To improve your health and your odds of a longer life, rigorous scientific evidence supports the benefits of: A.) being married; B.) exercising; C.) not smoking; D.) some of the above; E.) all of the above.

It’s a Valentine’s health quiz! And the answer—drum roll please—is D. Research has proved that exercising regularly and laying off the cigarettes will improve your health and likely add years to your life. Yet despite the popular perception that matrimony boosts health, the literature is less conclusive when it comes to the long-term health benefits of a legal union.

That doesn’t mean that marriage confers no health advantages. For one, a built-in support system can help partners tackle stress and a difficult medical diagnosis.

But with more than one in three people ages 50 to 64 divorced, widowed, separated, or never married, according to the Census Bureau, and more older adults living together without marrying, it’s worth thinking about the health benefits of partnerships in every form. And older Americans have another issue to consider: the impact of fewer traditional marriages on future caregiving needs. “Marriage comes with a script and cohabitation doesn’t,” said Susan L. Brown, co-director of the National Center for Family & Marriage Research at Bowling Green State University.

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They’re together ‘in sickness and in health,’ but does togetherness actually improve their health?

It seems as though every few months there’s a study out that shows that married people fare better in one health arena or another. Recently, for example, one found that married people survived a cancer diagnosis better than single people. But that study didn’t prove that marriage itself lowers the likelihood of death from cancer—it could, for example, be the social support that might be more readily available to a married person.

Indeed, there’s no way to test the benefits of marriage using the most rigorous scientific approach, the one scientists use to test drugs’ effectiveness. That would involve randomly assigning people to be married or to remain single. This approach could tease out the question of self-selection bias: For example, are healthy people more likely to marry, or does marriage foster better health? But an approach like this is impossible to use for marriage.

Studying couples takes patience

The next best methodology involves a so-called longitudinal study, following the same group of people over decades as they pass through various life stages, from being single to marriage to possibly divorce or widowhood, said Bella DePaulo, a visiting professor in social psychology at the University of California, Santa Barbara and author of “Singled Out: How singles are stereotyped, stigmatized, and ignored and still live happily ever after.”

The problem: Instead of a longitudinal approach, many researchers take a snapshot of the currently married and compare them to a slice of the currently single population, DePaulo said. But one study last year did take a long-term look at a huge population—about 789,000 people who participated in the National Health Interview Survey from 1986 to 2004.

Using this data, researchers looked at the likelihood of death over a three-year period among married people versus among their single counterparts. It found that a never-married person in self-reported “excellent” health is two times more likely to die within three years than a married person in similarly excellent health. However, in an interesting twist, the study found that among people who rated their health as poor, there is essentially no difference in the likelihood of death between married and unmarried people.

Why did marriage seem to protect the healthy but not the unhealthy? Hui Zheng, lead author of the study and an assistant professor of sociology at The Ohio State University, said that marriage may contribute to the prevention and early detection of disease—in other words, there’s something positive behind the stereotype of the wife nagging her husband to go to the doctor. Also, marriage can help spouses deal with stress.

Zheng’s data didn’t assess the quality of relationships. It’s possible that marital quality declines along with health, which is why marriage didn’t confer any mortality advantage for the unhealthy, he said. “It’s always stressful to be a caregiver, even for a spouse,” he said.

Cohabiting boosts happiness, if not health

There are fewer studies on the health benefits of cohabitation than there are on marriage, Brown said. One rare study that took a longitudinal approach to marriage and cohabitation found that married people fared better in health than cohabitors, but the opposite was true of happiness and self-esteem. More recently formed unions—those of three years’ duration or less—conferred the greatest benefits on happiness and easing of depressive symptoms.

That study, by researchers from Cornell University and the University of Wisconsin-Madison, focused on men and women under age 50, but it’s bound to be of interest to older adults. The number of adults over age 50 who were cohabiting more than doubled from 2000 to 2010, from 1.2 million to 2.8 million, according to analysis by Brown of the marriage resource center.

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